Electroconvulsive Therapy on Cognitive Functioning

Discuss about the Electroconvulsive Therapy on Cognitive Functioning.

The efficacy of the ECT in depression was found effective in both elders and younger patents. However, the efficacy was markedly greater in older patients than in younger.  Further, it was found effective in various areas of depression such as stroke, Parkinson’s disease, and melancholic depression (Kerner & Prudic, 2014). However, it can be criticised that it is not applicable for use in mild to moderate depression. In psychiatric conditions like Schizophrenia ECT alone cannot be used. There is need of administrating medication alongside (Williams, 2013).There is evidence that too much of ECT causes nerve instability and palpitations. ECT is underutilised in patients with Parkinson’s disease as the long term effects of ECT is unpredictable Further, there is also lack of parameters clarified for application and duration of therapeutic benefit in patients with severe depression in Parkinson’s disease (Narang et al., 2015). Further, there is also lack of evidence regarding the  efficacy of the ECT in a patient with psychotic depression along with active cushing disease.   There is no data so far published about the effect of ECT on Cortisol levels. Thus, the effect of the ECT on plasma level ACTH is debateable (van Rooijen et al., 2016).

There are evidences about negative effects of ECT in treating depression as there is possibility of temporary cognitive impairment after the treatment is over. There is a need of conclusive evidence on this argument (Oremus et al., 2015). There are evidences about the side effects of ECT on depressed people such as confusion, memory loss, and physical side effects. In patients with bilateral ECT long term memory loss can be a problem. (Kellner & Farber, 2016). According to Bodnar et al. (2016) after the ECT some patients reported with the significant worsening of memory and verbal fluency. Such effects on cognition are transient or not are questionable. It is argued to be transient as there is bulk of literature on long term favourable impact on the cognitive functions.

According to Bjølseth et al. (2015) cognitive function at baseline is less likely to predict ECT treatment outcome in elderly patients with major depression. If specific cognitive functions are impaired, then it may not be able to predict the short treatment outcome of formula based ECT. In similar other study by Verwijk et al. (2014) elderly patient who were severely depressed there was improvement in the neurocognitive function or some cases there was no change after ECT. Before, ECT some patients with poor cognitive function could not participate in neuropsychological assessment to be conducted before ECT. Therefore, it is difficult to apply these results  to patients with serious cognitive impairment before starting ECT.  The results partially argue that elders were more vulnerable to cognitive side effects after ECT.

Overall it can be concluded from the literature review that there are more positive effects of ECT than the negative effect. In order to strongly establish the negative effects of ECT on treating depression in several different areas needs intense research and validation.

References

Bjølseth, T. M., Engedal, K., Benth, J. Š., Dybedal, G. S., Gaarden, T. L., & Tanum, L. (2015). Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression. Journal of affective disorders, 185, 67-75.

Bodnar, A., Krzywotulski, M., Lewandowska, A., Chlopocka-Wozniak, M., Bartkowska-Sniatkowska, A., Michalak, M., & Rybakowski, J. K. (2016). Electroconvulsive therapy and cognitive functions in treatment-resistant depression. The World Journal of Biological Psychiatry, 17(2), 159-164.

Desarkar, P., Blumberger, D., & Daskalakis, Z. J. (2018). Case Report: Successful Use of the Combination of Electroconvulsive Therapy and Clozapine in Treating Treatment-Resistant Schizophrenia and Catatonia in an Adult with Intellectual Disability. Journal of autism and developmental disorders, 1-4.

Iancu, I., Pick, N., Seener-Lorsh, O., & Dannon, P. (2015). Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results. Neuropsychiatric disease and treatment, 11, 853.

Kellner, C. H., & Farber, K. G. (2016). Electroconvulsive therapy and cognition: a salutary reappraisal. Acta Psychiatrica Scandinavica, 134(6), 459-460.

Kerner, N., & Prudic, J. (2014). Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry, 4(1), 33.

Magnezi, R., Aminov, E., Shmuel, D., Dreifuss, M., & Dannon, P. (2016). comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness. Patient preference and adherence, 10, 1481.

Narang, P., Glowacki, A., & Lippmann, S. (2015). Electroconvulsive therapy intervention for Parkinson’s disease. Innovations in clinical neuroscience, 12(9-10), 25.

Oremus, C., Oremus, M., McNeely, H., Losier, B., Parlar, M., King, M., ... & Hanford, L. (2015). Effects of electroconvulsive therapy on cognitive functioning in patients with depression: protocol for a systematic review and meta-analysis. BMJ open, 5(3), e006966.

Van Rooijen, G., Denys, D., Fliers, E., & Nieuwdorp, M. (2016). Effective Electroconvulsive Therapy in a Patient With Psychotic Depression With Active Cushing Disease. The journal of ECT, 32(3), e20-e21.

Verwijk, E., Comijs, H. C., Kok, R. M., Spaans, H. P., Tielkes, C. E., Scherder, E. J., & Stek, M. L. (2014). Short-and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study. International psychogeriatrics, 26(2), 315-324.

Williams, J. M. G. (2013). The psychological treatment of depression. Routledge.